tetano
Editor, Senior Moderator
J Clin Transl Sci
. 2021 Jun 1;5(1):e8.
doi: 10.1017/cts.2020.489. eCollection 2021.
Safety of ACE-I and ARB medications in COVID-19: A retrospective cohort study of inpatients and outpatients in California
Samuel J S Rubin[SUP] #[/SUP][SUP] 1 [/SUP], Samuel R Falkson[SUP] #[/SUP][SUP] 1 [/SUP], Nicholas R Degner[SUP] #[/SUP][SUP] 1 [/SUP], Catherine A Blish[SUP] 1 2 [/SUP]
Affiliations
Abstract
Introduction: There is significant interest in the use of angiotensin converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARB) in coronavirus disease 2019 (COVID-19) and concern over potential adverse effects since these medications upregulate the severe acute respiratory syndrome coronavirus 2 host cell entry receptor ACE2. Recent studies on ACE-I and ARB in COVID-19 were limited by excluding outpatients, excluding patients by age, analyzing ACE-I and ARB together, imputing missing data, and/or diagnosing COVID-19 by chest computed tomography without definitive reverse transcription polymerase chain reaction (RT-PCR), all of which are addressed here.
Methods: We performed a retrospective cohort study of 1023 COVID-19 patients diagnosed by RT-PCR at Stanford Hospital through April 8, 2020 with a minimum follow-up time of 14 days to investigate the association between ACE-I or ARB use with outcomes.
Results: Use of ACE-I or ARB medications was not associated with increased risk of hospitalization, intensive care unit admission, or death. Compared to patients with charted past medical history, there was a lower risk of hospitalization for patients on ACE-I (odds ratio (OR) 0.43; 95% confidence interval (CI) 0.19-0.97; P = 0.0426) and ARB (OR 0.39; 95% CI 0.17-0.90; P = 0.0270). Compared to patients with hypertension not on ACE-I or ARB, patients on ARB medications had a lower risk of hospitalization (OR 0.09; 95% CI 0.01-0.88; P = 0.0381).
Conclusions: These findings suggest that the use of ACE-I and ARB is not associated with adverse outcomes and may be associated with improved outcomes in COVID-19, which is immediately relevant to care of the many patients on these medications.
Keywords: ACE inhibitors (ACE-I); COVID-19; SARS-CoV-2; angiotensin II receptor blockers (ARB); hypertension; renin-angiotensin-aldosterone system (RAAS); translational science.
. 2021 Jun 1;5(1):e8.
doi: 10.1017/cts.2020.489. eCollection 2021.
Safety of ACE-I and ARB medications in COVID-19: A retrospective cohort study of inpatients and outpatients in California
Samuel J S Rubin[SUP] #[/SUP][SUP] 1 [/SUP], Samuel R Falkson[SUP] #[/SUP][SUP] 1 [/SUP], Nicholas R Degner[SUP] #[/SUP][SUP] 1 [/SUP], Catherine A Blish[SUP] 1 2 [/SUP]
Affiliations
- PMID: 34611496
- PMCID: PMC7605244
- DOI: 10.1017/cts.2020.489
Abstract
Introduction: There is significant interest in the use of angiotensin converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARB) in coronavirus disease 2019 (COVID-19) and concern over potential adverse effects since these medications upregulate the severe acute respiratory syndrome coronavirus 2 host cell entry receptor ACE2. Recent studies on ACE-I and ARB in COVID-19 were limited by excluding outpatients, excluding patients by age, analyzing ACE-I and ARB together, imputing missing data, and/or diagnosing COVID-19 by chest computed tomography without definitive reverse transcription polymerase chain reaction (RT-PCR), all of which are addressed here.
Methods: We performed a retrospective cohort study of 1023 COVID-19 patients diagnosed by RT-PCR at Stanford Hospital through April 8, 2020 with a minimum follow-up time of 14 days to investigate the association between ACE-I or ARB use with outcomes.
Results: Use of ACE-I or ARB medications was not associated with increased risk of hospitalization, intensive care unit admission, or death. Compared to patients with charted past medical history, there was a lower risk of hospitalization for patients on ACE-I (odds ratio (OR) 0.43; 95% confidence interval (CI) 0.19-0.97; P = 0.0426) and ARB (OR 0.39; 95% CI 0.17-0.90; P = 0.0270). Compared to patients with hypertension not on ACE-I or ARB, patients on ARB medications had a lower risk of hospitalization (OR 0.09; 95% CI 0.01-0.88; P = 0.0381).
Conclusions: These findings suggest that the use of ACE-I and ARB is not associated with adverse outcomes and may be associated with improved outcomes in COVID-19, which is immediately relevant to care of the many patients on these medications.
Keywords: ACE inhibitors (ACE-I); COVID-19; SARS-CoV-2; angiotensin II receptor blockers (ARB); hypertension; renin-angiotensin-aldosterone system (RAAS); translational science.